Provider Demographics
NPI:1811218142
Name:AGHIA, GEORGE ANTOINE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ANTOINE
Last Name:AGHIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16151 WEBER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0863
Mailing Address - Country:US
Mailing Address - Phone:815-838-2888
Mailing Address - Fax:
Practice Address - Street 1:16151 WEBER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0863
Practice Address - Country:US
Practice Address - Phone:815-838-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01968207Q00000X
IL036-133237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036133237Medicaid
IL036133237Medicaid
IL0727500008Medicare NSC